Integration works!

As delegates gather this week for the 2016 International Conference on Family Planning in Nusa Dua, Indonesia, they will celebrate the hard won success of bringing family planning back on the global development agenda. However, for women living with HIV and young people in all their diversity, the daily struggle to access services puts the achievement of the FP2020 targets at risk.

Divya Bajpal, Senior Advisor, SRHR & HIV sets out what can be learnt from the HIV community.

Whilst promising progress has been made towards these commitments, in order to fully expand access to family planning services to 120 million additional women and girls, it is going to be critical to ensure that the hardest to reach women and girls are not left behind and that their broader sexual and reproductive health and rights (SRHR) are improved.

A youth group in the Malnicherra tea plantation in Sylhet, Bangladesh that raises awareness of sexual and reproductive health and rights

How can services ‘link up’?

The Alliance experience of implementing SRHR services which are integrated into HIV programmes is based on two separate but connected approaches: person-centered health-service delivery which is more responsive to the diverse sexual and reproductive health needs of women and girls and their partners, and human rights based approaches towards advocating for SRHR and HIV integration.

Applying lessons learned and engaging affected communities not only as clients and end-users, but also as active participants, leads to more tailored services which can fulfil the unmet family planning and broader SRHR needs of even the most marginalised communities.

The critical role of health service providers

The success of this approach has been keenly demonstrated through Link Up, an ambitious programme funded by the Ministry of Foreign Affairs of the Netherlands (BUZA) which aims to improve the SRHR of more than one million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. By the end of 2015, the project had already reached nearly 600,000 young people aged 10-24 affected by HIV/SRHR services in a community or home based setting.

Link Up has proved how vital it is for health service providers to listen to young people, and provide quality age-appropriate, key population friendly, family planning and other SRHR services. To do this, in each country the project has provided training to change the mindsets and values of health service providers and challenge the stigma and discrimination young people face. To date, the project has trained nearly 2,000 health providers on how to provide quality integrated SRHR services. For example, how to ensure safer sex counselling covers preventing unintended pregnancy as well as HIV and other STIs, and consistently promoting condoms alongside longer term contraceptive methods for dual protection. Since the project started in 2013, 380,000 young people have received family planning services, information and commodities, and over 160,000 have accessed integrated HIV and family planning, or HIV and STI services.

Despite progress, more change is needed. There is still a lack of incentive for health service providers to take this approach and the most common assessment, the Couple Years of Protection, makes no allowance for adapting the advice to meets the needs of different individuals based on their age, key population, and other risk factors.

Listen, adapt, learn

Youth leadership and the power of youth engagement at all levels of the project also serves to strengthen the design, delivery and monitoring of policies and services. The experience of youth engagement gained through the Link Up programme has been documented in a new tool to be released later this year, Aiming High for Meaningful Youth Engagement. Watch this space!

But already Link Up has generated a whole raft of tools to help health care workers adapt their services – specifically those who provide family planning services to young people:

A workshop guide Integration works! which enables participants to explore the benefits and challenges of integrating sexual and reproductive health and rights and HIV

A five-day 101 training programme on SRHR and HIV integration with the objective of making service providers more aware of the needs of young people selling sex, young people living with HIV, MSM youth and transgender advocates (aged 10-24), and thereby decreasing stigma and increasing client satisfaction.

In the next five years, it will be critical for health care providers who want to strengthen community access to and uptake of family planning and SRHR services to apply the lessons learned from effective community mobilisation and rights based programming for HIV.

As funding for HIV specific projects and services becomes scarcer, the sexual health needs of women living with HIV and young people in all their diversity can only be met by the family planning movement. This entails ensuring that more people can access health services, particularly those from marginalised communities who are most vulnerable to and/or affected by HIV and who have significant unmet needs for family planning and sexual and reproductive health services. Only then will we maximise the global impetus towards the FP2020 commitments and the Sustainable Development Goals.